Changes in covering maternity costs
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Description
Two months after defining the new Medical Expenses for Hospitals in the National Health System (ESY), the procedure covering maternity care was modified and provided that for natural or caesarean childbirth in a public hospital, the childbirth benefit would not be granted to the beneficiary by the social security organizations; instead, the hospital’s maternity expenses would be paid directly to the hospital by the latter.
The Ombudsman noticed that there were malfunctions in the procedure covering maternity expenses, as well as confusion of competence among social security organizations and hospitals, caused by procedural irregularities or delayed access to concise information. Certain public hospitals asked the insured mothers to pay the hospital expenses in order to be released from the hospital and be given the medical discharge certificate after delivery, despite the fact that maternity hospital expenses are normally covered fully by their social security organizations. Following the Ombudsman’s mediation, the hospitals offered to refund the money.
In other cases, a certain number of insured mothers who had been granted the benefit were then charged with a difference in the childbirth expenses. Following the Ombudsman’s mediation, the hospitals refunded the insured mothers with the wrongly paid amount of money, while the insured mothers returned the benefit they had received and thus the procedure for covering the maternity expenses by the social security organizations was activated.
In cases where insured mothers had paid the maternity expenses to the hospital and their request for the benefit had been rejected on the grounds of the legislative amendment, the Ombudsman intervened and the benefits for which the applications had been submitted before the end of 2011 were paid to the insured mothers.
